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& Science Organization and Professional Society Statements on the Use of Low-Calorie Sweeteners</a></h1></div></div> <div class='container_wrap container_wrap_first main_color fullsize'> <div class='container'> <main class='template-page content av-content-full alpha units' role="main" itemprop="mainContentOfPage" > <article class='post-entry post-entry-type-page post-entry-4652' itemscope="itemscope" itemtype="https://schema.org/CreativeWork" > <div class="entry-content-wrapper clearfix"> <header class="entry-content-header"></header><div class="entry-content" itemprop="text" ><div class="fl-builder-content fl-builder-content-4652 fl-builder-content-primary fl-builder-global-templates-locked" data-post-id="4652"><div class="fl-row fl-row-full-width fl-row-bg-photo fl-node-5b733bd3750c5 fl-row-custom-height fl-row-align-center fl-row-bg-fixed" data-node="5b733bd3750c5"> <div class="fl-row-content-wrap"> <div class="fl-row-content fl-row-full-width fl-node-content"> <div class="fl-col-group fl-node-5b733bd37517e" data-node="5b733bd37517e"> <div class="fl-col fl-node-5b733bd375123" data-node="5b733bd375123"> <div class="fl-col-content fl-node-content"></div> </div> </div> </div> </div> </div> <div class="fl-row fl-row-fixed-width fl-row-bg-none fl-node-5b733bd374f52 fl-row-default-height fl-row-align-center" data-node="5b733bd374f52"> <div class="fl-row-content-wrap"> <div class="fl-row-content fl-row-fixed-width fl-node-content"> <div class="fl-col-group fl-node-5b733bd374fba" data-node="5b733bd374fba"> <div class="fl-col fl-node-5b733bd37501c" data-node="5b733bd37501c"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-rich-text fl-node-5b733bd37544e fl-animation fl-fade-in" data-node="5b733bd37544e" data-animation-delay="0.0" data-animation-duration="1"> <div class="fl-module-content fl-node-content"> <div class="fl-rich-text"> <p>The following is a list of publicly available statements on the use of low-calorie sweeteners. It is not intended to be a comprehensive list. When available, each entry includes both a statement published in the linked paper or report, as well as a statement from the organizational website. IAFNS does not endorse the statements shown, nor does it have an opinion on the value of the organizations listed; the website is for informational purposes only.</p> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="fl-row fl-row-fixed-width fl-row-bg-none fl-node-t2jb0y8aklnd fl-row-default-height fl-row-align-center" data-node="t2jb0y8aklnd"> <div class="fl-row-content-wrap"> <div class="fl-row-content fl-row-fixed-width fl-node-content"> <div class="fl-col-group fl-node-pbevfj3t81ig" data-node="pbevfj3t81ig"> <div class="fl-col fl-node-jb40kn7etqxa fl-col-has-cols" data-node="jb40kn7etqxa"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-rich-text fl-node-5b733bd3755bf" data-node="5b733bd3755bf"> <div class="fl-module-content fl-node-content"> <div class="fl-rich-text"> <h2><span class="color-quaternary" style="font-size: 30px;">Global Health & Science Organization Statements on the Use of Low-Calorie Sweeteners</span></h2> </div> </div> </div> <div class="fl-col-group fl-node-mlaonkpf6bj8 fl-col-group-nested" data-node="mlaonkpf6bj8"> <div class="fl-col fl-node-fpql82ik5cgo fl-col-small" data-node="fpql82ik5cgo"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-accordion fl-node-5b733bd375848" data-node="5b733bd375848"> <div class="fl-module-content fl-node-content"> <div class="fl-accordion fl-accordion-small fl-accordion-collapse"> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375848-tab-0" aria-controls="fl-accordion-5b733bd375848-panel-0" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375848-label-0" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375848-panel-0">Diabetes United Kingdom</a> <a href="#" id="fl-accordion-5b733bd375848-icon-0" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375848-panel-0" aria-labelledby="fl-accordion-5b733bd375848-tab-0" aria-hidden="true"> <p><a href="https://www.diabetes.org.uk/">https://www.diabetes.org.uk/</a></p> <p>2018</p> <p><strong>The Use of Low or No Calorie Sweeteners: Position Statement</strong></p> <ul> <li>Safety: The use of LNCS remains safe with current intake levels within the ADIs. Any new safety issues arising from new research are regularly monitored.</li> <li>Diabetes Management: Replacing free sugars with LNCS can be a helpful strategy to aid glucose management.</li> <li>Cardiovascular Disease: “There is not enough evidence to say that the consumption of LNCS leads to the development of hypertension, stroke or dementia.”</li> </ul> <p><a href="https://www.diabetes.org.uk/resources-s3/2019-02/Our position on the use of low or no calorie sweeteners.pdf">Click here for additional detail</a></p> <p><strong>Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes</strong></p> <p>“Non-nutritive (artificial) sweeteners are safe and may be recommended.”</p> <p><strong>Evaluation methodology:</strong> GRADE</p> <p><strong>Rating:</strong> NR</p> <p><strong>Rating interpretation:</strong> NR (not rated). Rationale: “A key aspect of current approaches to supporting people with diabetes is to encourage practice that is individualized. It is challenging to rate such recommendations using the GRADE system, particularly in situations where multiple conditions influence health and dietary approaches. In response to this, a deliberate decision was made to report these recommendations as “Not Rated.”</p> <p><a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.13603">Click here for additional detail</a>.</p> <p><strong><a href="https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/carbohydrates-and-diabetes/sugar-sweeteners-and-diabetes#sweeteners%20and%20safety">Website statement</a>:</strong> “All non-nutritive sweeteners used in foods in the EU have to undergo rigorous safety testing before being approved by the European Commission.”</p> <h6><em>Resources accessed July 2024.</em></h6> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375848-tab-1" aria-controls="fl-accordion-5b733bd375848-panel-1" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375848-label-1" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375848-panel-1">National Institutes of Health</a> <a href="#" id="fl-accordion-5b733bd375848-icon-1" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375848-panel-1" aria-labelledby="fl-accordion-5b733bd375848-tab-1" aria-hidden="true"> <p><a href="https://www.nih.gov/">https://www.nih.gov/</a></p> <p>2016</p> <p><strong>Artificial Sweeteners and Cancer</strong></p> <p>“Questions about artificial sweeteners and cancer arose when early studies showed that cyclamate in combination with saccharin caused bladder cancer in laboratory animals. However, results from subsequent carcinogenicity studies (studies that examine whether a substance can cause cancer) of these sweeteners have not provided clear evidence of an association with cancer in humans. Similarly, studies of other FDA-approved sweeteners have not demonstrated clear evidence of an association with cancer in humans.”</p> <p><strong>Evaluation methodology:</strong> Not applicable</p> <p><a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet">Click here for additional detail</a>.</p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> </div> </div> </div> </div> </div> <div class="fl-col fl-node-lfpnq90rxeio fl-col-small" data-node="lfpnq90rxeio"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-accordion fl-node-5b733bd37595d" data-node="5b733bd37595d"> <div class="fl-module-content fl-node-content"> <div class="fl-accordion fl-accordion-small fl-accordion-collapse"> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd37595d-tab-0" aria-controls="fl-accordion-5b733bd37595d-panel-0" tabindex="0"> <a href="#" id="fl-accordion-5b733bd37595d-label-0" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd37595d-panel-0">Pan American Health Organization</a> <a href="#" id="fl-accordion-5b733bd37595d-icon-0" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd37595d-panel-0" aria-labelledby="fl-accordion-5b733bd37595d-tab-0" aria-hidden="true"> <p><a href="https://www.paho.org/en">https://www.paho.org/en</a></p> <p>2016</p> <p><strong>The Pan American Health Organization Nutrient Profile Model</strong></p> <p>III. Principles and rationale of the PAHO Nutrient Profile Model<br /> “In addition to critical nutrients, “other sweeteners” were included in the model. The rationale for their inclusion is that habitual use of sweet flavors (sugar-based or not) promotes the intake of sweet food and drinks, including those that contain sugars. This outcome is particularly important in young children because consumption at an early age defines lifelong consumption patterns.”</p> <p>“Criteria for identifying processed and ultra-processed products…” includes “Other sweeteners” defined as “Any amount of other sweeteners.”</p> <p><strong>Methodology:</strong> Not specified</p> <p><a href="http://iris.paho.org/xmlui/bitstream/handle/123456789/18621/9789275118733_eng.pdf?sequence=9&isAllowed=y" target="_blank" rel="noopener">Click here for additional detail. </a></p> <p><em><span style="font-size: 12px;">Resources accessed July 2024.</span></em></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd37595d-tab-1" aria-controls="fl-accordion-5b733bd37595d-panel-1" tabindex="0"> <a href="#" id="fl-accordion-5b733bd37595d-label-1" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd37595d-panel-1">World Health Organization</a> <a href="#" id="fl-accordion-5b733bd37595d-icon-1" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd37595d-panel-1" aria-labelledby="fl-accordion-5b733bd37595d-tab-1" aria-hidden="true"> <p><a href="https://www.who.int/">https://www.who.int/</a></p> <p>2023</p> <p><strong>WHO Guideline on Use of Non-Sugar Sweeteners</strong></p> <p>“WHO suggests that NSS not be used as a means of achieving weight control or reducing risk of noncommunicable diseases (conditional recommendation).”</p> <p><strong>Methodology: </strong>Systematic reviews</p> <p><a href="https://iris.who.int/bitstream/handle/10665/367660/9789240073616-eng.pdf?sequence=1" target="_blank" rel="noopener">Click here for additional detail</a></p> <p>2016</p> <p><strong>Policy statement and recommended actions for lowering sugar intake and reducing prevalence of type 2 diabetes and obesity in the Eastern Mediterranean Region</strong></p> <p>“The need to help the population adapt to less sweetened foods also means that the use of sweeteners, while successful in reducing calories, does not help this adaptive process in people’s sense of appropriate sweetness.”</p> <p><strong>Methodology:</strong> Not specified</p> <p><a href="http://www.emro.who.int/pdf/nutrition/strategy/policy-statement-and-recommended-actions-for-lowering-sugar-intake-and-reducing-prevalence-of-type-2-diabetes-and-obesity-in-the-eastern-mediterranean-region.pdf?ua=1" target="_blank" rel="noopener">Click here for additional detail.</a></p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="fl-row fl-row-fixed-width fl-row-bg-none fl-node-ejfpvl462sbm fl-row-default-height fl-row-align-center" data-node="ejfpvl462sbm"> <div class="fl-row-content-wrap"> <div class="fl-row-content fl-row-fixed-width fl-node-content"> <div class="fl-col-group fl-node-xjuvspic47ew" data-node="xjuvspic47ew"> <div class="fl-col fl-node-nvuk4i91ba5q fl-col-has-cols" data-node="nvuk4i91ba5q"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-rich-text fl-node-5b733bd3756c8" data-node="5b733bd3756c8"> <div class="fl-module-content fl-node-content"> <div class="fl-rich-text"> <h2><span class="color-quaternary" style="font-size: 30px;">Professional Society Statements on the Use of Low-Calorie Sweeteners</span></h2> </div> </div> </div> <div class="fl-col-group fl-node-wza9x83tjyn6 fl-col-group-nested" data-node="wza9x83tjyn6"> <div class="fl-col fl-node-erpoyb0ghxdu fl-col-small" data-node="erpoyb0ghxdu"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-accordion fl-node-5b733bd375a59" data-node="5b733bd375a59"> <div class="fl-module-content fl-node-content"> <div class="fl-accordion fl-accordion-small fl-accordion-collapse"> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a59-tab-0" aria-controls="fl-accordion-5b733bd375a59-panel-0" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a59-label-0" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a59-panel-0">Academy of Nutrition & Dietetics</a> <a href="#" id="fl-accordion-5b733bd375a59-icon-0" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a59-panel-0" aria-labelledby="fl-accordion-5b733bd375a59-tab-0" aria-hidden="true"> <p><a href="https://www.eatright.org/">https://www.eatright.org/</a></p> <p>2023</p> <p><strong>Academy of Nutrition and Dietetics Statement: Aspartame</strong></p> <p>The Academy will continue to support the recommendations of registered dietitian nutritionists, the food and nutrition experts, who accept the use of non-nutritive sweeteners, including aspartame, by their patients and clients within accepted daily limits until further evidence can be generated</p> <p><a href="https://www.eatrightpro.org/about-us/for-media/press-releases/academy-statement-on-aspartame">Click here for additional detail</a></p> <p>2018</p> <p><strong>Position Paper: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes</strong></p> <p>“Nutrition intervention: The RDN should individualize the nutrition prescription and implement evidence-based guidelines in collaboration with the adult with diabetes [including to] Educate on carbohydrate management strategies including fiber, glycemic index, and sweetener (nutritive and non-nutritive) recommendations…”</p> <p><strong>Evaluation methodology:</strong> Narrative review</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="https://jandonline.org/article/S2212-2672(17)31849-X/abstract">Click here for additional detail</a>.</p> <p>2017</p> <p><strong>Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Nutrition Intervention Evidence Reviews and Recommendations</strong></p> <p><strong>Nutrition Practice Guideline Recommendations:</strong><br /> 1. “RDNs should educate adults with diabetes that intake of FDA-approved nonnutritive sweeteners (such as aspartame, sucralose, and steviol glycosides) within the recommended daily intake levels established by the FDA will not have a significant influence on glycemic control. Research reports no significant influence of consuming FDA-approved nonnutritive sweeteners (such as aspartame, steviol glycosides, and sucralose), independent of weight loss, on HbA1c, fasting glucose levels, or insulin levels.”</p> <p><strong>Evaluation methodology:</strong> Systematic review</p> <p><strong>Rating:</strong> Weak; Imperative</p> <p><strong>Rating interpretation:</strong> Weak = “Quality of evidence is either suspect or well-done studies show little clear advantage to one approach vs another”; Imperative = “Applies to all members of the specified guidelines population”</p> <p>2. “RDNs should educate adults with diabetes that substituting foods and beverages containing FDA-approved nonnutritive sweeteners within the recommended daily intake levels established by FDA can reduce overall calorie and carbohydrate intake; however, the other sources of calories and carbohydrates in these foods and beverages need to be considered. Use of nonnutritive sweeteners has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources.”</p> <p><strong>Evaluation methodology:</strong> Systematic review</p> <p><strong>Rating:</strong> Fair; Imperative</p> <p><strong>Rating interpretation:</strong> Fair = “Quality of evidence is II [fair] or III [limited]”; Imperative = “Applies to all members of the specified guidelines population”</p> <p><a href="https://jandonline.org/article/S2212-2672(17)30332-5/fulltext" target="_blank" rel="noopener">Click here for additional detail</a>.</p> <p>2016</p> <p><strong>Position Paper: Interventions for the Treatment of Overweight and Obesity in Adults</strong></p> <p>“Reducing [sugar-sweetened beverages] should be helpful for weight management if compensation to the reduction in energy consumed from SSB does not occur and if energy-containing beverages are not consumed in place of SSB when SSB are reduced.” The document references two papers showing that replacement of SSBs with diet beverages resulted in weight loss of at least 2 percent and reduced subjective ratings of hunger, respectively.</p> <p><strong>Evaluation methodology:</strong> Narrative review</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/26718656/" target="_blank" rel="noopener">Click here for additional detail</a>.</p> <p>2012</p> <p><strong>Position paper: Use of Nutritive and Nonnutritive Sweeteners</strong></p> <p>“It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive and nonnutritive sweeteners when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference.”</p> <p><a href="https://jandonline.org/article/S2212-2672(12)00325-5/fulltext">Click here for additional detail.</a></p> <p><a href="https://www.eatright.org/food/nutrition/dietary-guidelines-and-myplate/sugar-substitutes-how-much-is-too-much"><strong>Website statement:</strong></a> “Regulatory agencies set Acceptable Daily Intake (ADI) levels for each artificial sweetener. The ADI is the maximum amount of a food additive that can be safely consumed on a daily basis over a person's lifetime without any adverse effects. Although the number of diet soft drinks and other "sugar free" products we devour may seem high, the U.S. intake of sugar substitutes is actually well below the ADI even for the heaviest users, namely dieters, adults, children with diabetes and women of child-bearing age.”</p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a59-tab-1" aria-controls="fl-accordion-5b733bd375a59-panel-1" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a59-label-1" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a59-panel-1">Academy of Nutrition and Dietetics, American Academy of Pediatric Dentistry, American Academy of Pediatrics and the American Heart Association</a> <a href="#" id="fl-accordion-5b733bd375a59-icon-1" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a59-panel-1" aria-labelledby="fl-accordion-5b733bd375a59-tab-1" aria-hidden="true"> <p>2019</p> <p><strong>Healthy Beverage Consumption in Early Childood</strong></p> <p>Beverages with Low-Calorie Sweeteners, Ages 0 – 5: Not Recommended</p> <p>“This recommendation is based on expert opinion given that early childhood is a critical developmental period, and there is a lack of evidence regarding the long-term health impact(s) of LCS consumption in young children.”</p> <p><strong>Evaluation methdology: </strong>Five-step methodology, including review of existing recommendations, literature review and expert panel discussion. See reference below for additional details.</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="https://healthyeatingresearch.org/research/technical-scientific-report-healthy-beverage-consumption-in-early-childhood-recommendations-from-key-national-health-and-nutrition-organizations/" target="_blank" rel="noopener">Click here for additional detail</a>.</p> <p><span style="font-size: 12px;"><em>Resource accessed July 2024</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a59-tab-2" aria-controls="fl-accordion-5b733bd375a59-panel-2" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a59-label-2" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a59-panel-2">American Academy of Pediatrics</a> <a href="#" id="fl-accordion-5b733bd375a59-icon-2" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a59-panel-2" aria-labelledby="fl-accordion-5b733bd375a59-tab-2" aria-hidden="true"> <p><a href="https://www.aap.org/">https://www.aap.org/</a></p> <p>2019</p> <p><strong>The Use of Nonnutritive Sweeteners in Children</strong></p> <p>“Guidance for Pediatricians:</p> <p>Primary health care providers should discuss with parents and patients (as appropriate) the available evidence regarding the benefits and harms of NNS use in children and adolescents. The AAP recommends that pediatricians discuss the following points with families:</p> <p>1. NNSs are FDA approved for use in humans or are GRAS and, thereby, approved for use under the GRAS designation.<br /> 2. The GRAS designation is based on consumption of NNSs within an ADI level; it is not possible to measure an individual’s daily intake of NNSs at this time.<br /> 3. Higher-quality data suggest that NNS use is associated with weight stabilization and/or weight loss in the short-term. Currently, there is a paucity of longterm data.<br /> 4. High-quality evidence, including meta-analysis and data from RCTs, suggests that there is no association between hyperactivity and NNS use in children.”<br /> 5. There are limited data regarding the effect of NNS use on appetite change and taste preference."</p> <p><strong>Evaluation methodology:</strong> Literature review & review of statements from authoritative organizations</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="https://pediatrics.aappublications.org/content/early/2019/10/25/peds.2019-2765" target="_blank" rel="noopener">Click here for additional detail</a>.</p> <p><em><span style="font-size: 12px;">Resources accessed November 2019.</span></em></p> <p> </p> <p>2015</p> <p><strong>Policy Statement from Council on School Health, Committee on Nutrition. Snacks, Sweetened Beverages, Added Sugars, and Schools.</strong></p> <p>“Additional improvements in nutrient density of sweet-tasting products could be obtained if nonnutritive sweeteners are used as a tool to replace added sugars and help lower caloric intake. Several nonnutritive sweeteners have been accepted by the US Food and Drug Administration as safe and have shown good safety over time. However, data are scarce on long-term benefits for weight management in children and adolescents or on the consequences of long-term consumption. Continued research is needed.”</p> <p><strong>Evaluation methodology:</strong> Narrative review</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="http://pediatrics.aappublications.org/content/pediatrics/early/2015/02/17/peds.2014-3902.full.pdf">Click here for additional detail</a>.</p> <p><a href="https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Sweeteners-and-Sugar-Substitutes.aspx"><strong>Website statement:</strong></a> “Due to limited studies in children, the American Academy of Pediatrics (AAP) has no official recommendations regarding the use of noncaloric sweeteners.”</p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a59-tab-3" aria-controls="fl-accordion-5b733bd375a59-panel-3" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a59-label-3" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a59-panel-3">American Association of Clinical Endocrinologists/The American College of Endocrinology</a> <a href="#" id="fl-accordion-5b733bd375a59-icon-3" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a59-panel-3" aria-labelledby="fl-accordion-5b733bd375a59-tab-3" aria-hidden="true"> <p><a href="https://www.aace.com/">https://www.aace.com/</a></p> <p>2017</p> <p><a href="https://www.endocrine.org/news-room/current-press-releases/low-calorie-sweeteners-promote-fat-accumulation-in-human-fat"><strong>Website statement</strong> (2017 press release):</a> “Low-calorie sweeteners promote fat accumulation in human fat.”</p> <p>2013</p> <p><strong>Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults</strong></p> <p>“Patients with DM may safely consume artificial sweeteners within the guidelines of the U.S. Food and Drug Administration (FDA).”</p> <p><strong>Evaluation methodology:</strong> AACE Protocol for Standardized Production of Clinical Practice Guidelines – 2010</p> <p><strong>Rating:</strong> Grade D, Best Evidence Level 1</p> <p><strong>Rating interpretation:</strong> Expert opinion when there is lack of conclusive clinical evidence. Best evidence level (BEL) 1 = strong</p> <p><a href="https://pro.aace.com/disease-state-resources/nutrition-and-obesity/clinical-practice-guidelines/clinical-practice" target="_blank" rel="noopener">Click here for additional detail</a>.</p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a59-tab-4" aria-controls="fl-accordion-5b733bd375a59-panel-4" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a59-label-4" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a59-panel-4">American Cancer Society</a> <a href="#" id="fl-accordion-5b733bd375a59-icon-4" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a59-panel-4" aria-labelledby="fl-accordion-5b733bd375a59-tab-4" aria-hidden="true"> <p><a href="https://www.cancer.org/">https://www.cancer.org/</a></p> <p>2016</p> <p><strong>Guidelines on Nutrition and Physical Activity for Cancer Prevention and Physical Activity for Cancer Prevention</strong></p> <p>“There is no proof that these sweeteners, at the levels consumed in human diets, cause cancer. Aspartame, saccharin, and sucralose are a few of the non-nutritive sweeteners approved for use by the FDA. Current evidence does not show a link between these compounds and increased cancer risk. Some animal studies have suggested that their use may be linked with an increased risk of cancers of the bladder and brain, or of leukemias and lymphomas, but studies in humans show no increased cancer risk. People with the genetic disorder phenylketonuria, however, should avoid aspartame in their diets.</p> <p>Newer sugar substitutes include sweeteners such as sugar alcohols (sorbitol, xylitol, and mannitol) and naturally derived sweeteners (stevia and agave syrup). All of these sweeteners appear to be safe when used in moderation, although larger amounts of sugar alcohols may cause bloating and stomach discomfort in some people.”</p> <p><strong>Evaluation methodology:</strong> Literature and report review</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="https://oralcancerfoundation.org/wp-content/uploads/2016/09/guidelines-during-cancer.pdf">Click here for additional detail</a>.</p> <p><a href="https://www.cancer.org/cancer/cancer-causes/aspartame.html"><strong>Website statement:</strong></a> “Expert agencies in the United States and elsewhere that have evaluated aspartame have found it safe for use.”</p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a59-tab-5" aria-controls="fl-accordion-5b733bd375a59-panel-5" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a59-label-5" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a59-panel-5">American Diabetes Association</a> <a href="#" id="fl-accordion-5b733bd375a59-icon-5" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a59-panel-5" aria-labelledby="fl-accordion-5b733bd375a59-tab-5" aria-hidden="true"> <p><a href="https://diabetes.org/">https://diabetes.org/</a></p> <p><strong>2024</strong></p> <p><strong>Standards of Medical Care in Diabetes</strong></p> <p>Counsel people with prediabetes and diabetes that water is recommended over nutritive and nonnutritive sweetened beverages. However, the use of nonnutritive sweeteners as a replacement for sugar-sweetened products in moderation is acceptable if it reduces overall calorie and carbohydrate intake</p> <p><a href="https://diabetesjournals.org/care/issue/47/Supplement_1">Click here for additional detail</a></p> <p class="xmsonormal"><strong><span style="color: #0070c0;">2023</span></strong></p> <p class="xmsonormal"><strong><span style="color: #0070c0;">Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes</span></strong></p> <p class="xmsonormal">"5.17 People with diabetes and those at risk are advised to replace sugar-sweetened beverages (including fruit juices) with water or low calorie, no calorie beverages as much as possible to manage glycemia and reduce risk for cardiometabolic disease. B and minimize consumption of foods with added sugar that have the capacity to displace healthier, more nutrient-dense food choices. A”</p> <p class="xmsonormal"><b>Evaluation methodology</b>: ADA evidence-grading system</p> <p class="xmsonormal"><b>Rating: </b>A</p> <p class="xmsonormal"><b>Rating interpretation:</b> “Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered, including:<b> </b>Evidence from a well-conducted multicenter trial, Evidence from a meta-analysis that incorporated quality ratings in the analysis;</p> <p class="xmsonormal">Supportive evidence from well-conducted randomized controlled trials that are adequately powered, including: Evidence from a well-conducted trial at one or more institutions, Evidence from a meta-analysis that incorporated quality ratings in the analysis”</p> <p class="xmsonormal"><b>Rating:</b> B</p> <p class="xmsonormal"><b>Rating interpretation:</b> “Supportive evidence from well-conducted cohort studies: Evidence from a well-conducted prospective cohort study or registry, evidence from a well-conducted meta-analysis of cohort studies; supportive evidence from a well-conducted case-control study.”</p> <p class="xmsonormal"><a href="https://diabetesjournals.org/care/article/46/Supplement_1/S68/148055/5-Facilitating-Positive-Health-Behaviors-and-Well" target="_blank" rel="noopener">Click here for additional information</a></p> <p class="xmsonormal"><strong>2020</strong></p> <p class="xmsonormal"><strong>Standards of Medical Care in Diabetes</strong></p> <p class="xmsonormal">“The use of nonnutritive sweeteners may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. For those who consume sugar sweetened beverages regularly, a low-calorie or nonnutritive-sweetened beverage may serve as a short-term replacement strategy, but overall, people are encouraged to decrease both sweetened and nonnutritive-sweetened beverages and use other alternatives, with an emphasis on water intake.”</p> <p class="xmsonormal"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969656/" target="_blank" rel="noopener">Click here for additional detail</a></p> <p class="xmsonormal"><strong>Evaluation methodology</strong>: ADA evidence-grading system</p> <p class="xmsonormal"><strong>Rating</strong>: B</p> <p class="xmsonormal"><b>Rating interpretation:</b> “Supportive evidence from well-conducted cohort studies: Evidence from a well-conducted prospective cohort study or registry, evidence from a well-conducted meta-analysis of cohort studies; supportive evidence from a well-conducted case-control study.”</p> <p> </p> <p><strong>2019</strong></p> <p><strong>Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report</strong></p> <p>“Replace sugar-sweetened beverages (SSBs) with water as often as possible. When sugar substitutes are used to reduce overall calorie and carbohydrate intake, people should be counseled to avoid compensating with intake of additional calories from other food sources."</p> <p><a href="https://care.diabetesjournals.org/content/diacare/42/5/731.full.pdf" target="_blank" rel="noopener">Click here for additional detail</a>:</p> <p><strong>Evaluation methodology</strong>: “The 2014 position statement was used as a starting point, and a search was conducted on PubMed for studies published in English between 1 January 2014 and 28 February 2018 to provide the updated evidence of nutrition therapy interventions in non-hospitalized adults with prediabetes and type 1 and type 2 diabetes. Details on the keywords and the search strategy are reported in the Supplementary Data, emphasizing randomized controlled trials (RCTs), systematic reviews, and metanalyses…. in select cases the authors identified relevant research to include in reaching consensus.”</p> <p><strong>Rating</strong>: Not applicable.</p> <p><strong>Rating interpretation</strong>: Not applicable.</p> <p> </p> <p><strong>2018</strong></p> <p><strong>Standards of Medical Care in Diabetes</strong></p> <p>“The use of nonnutritive sweeteners may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. Nonnutritive sweeteners are generally safe to use within the defined acceptable daily intake levels.”</p> <p><a href="https://diabetesed.net/wp-content/uploads/2017/12/2018-ADA-Standards-of-Care.pdf">Click here for additional detail</a>.</p> <p><strong>Evaluation methodology:</strong> ADA evidence-grading system</p> <p><strong>Rating:</strong> B</p> <p><strong>Rating interpretation:</strong> “Supportive evidence from well-conducted cohort studies: Evidence from a well-conducted prospective cohort study or registry, evidence from a well-conducted meta-analysis of cohort studies; supportive evidence from a well-conducted case-control study”</p> <p> </p> <p><strong>2014</strong></p> <p><strong>Position Statement: Nutrition Therapy Recommendations for the Management of Adults with Diabetes</strong></p> <p>“Use of NNSs has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources.”</p> <p><strong>Evaluation methodology:</strong> As above</p> <p><strong>Rating:</strong> B</p> <p><strong>Rating interpretation:</strong> As above</p> <p><a href="http://care.diabetesjournals.org/content/37/Supplement_1/S120.long">Click here for additional detail</a>.</p> <p> </p> <p><strong>2012</strong></p> <p><strong>Scientific Statement: Nonnutritive Sweeteners: Current Use and Health Perspectives</strong><br /> <em>American Diabetes Association and the American Heart Association</em></p> <p>“The evidence reviewed suggests that when used judiciously, NNS could facilitate reductions in added sugars intake, thereby resulting in decreased total energy and weight loss/weight control, and promoting beneficial effects on related metabolic parameters.”</p> <p><strong>Evaluation methodology:</strong> Literature search</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402256/pdf/1798.pdf">Click here for additional detail</a>.</p> <p><a href="http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/artificial-sweeteners/"><strong>Website statement:</strong></a> “Foods and drinks that use artificial sweeteners are another option that may help curb your cravings for something sweet.”</p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> </div> </div> </div> </div> </div> <div class="fl-col fl-node-se1zum067kil fl-col-small" data-node="se1zum067kil"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-accordion fl-node-5b733bd375a9b" data-node="5b733bd375a9b"> <div class="fl-module-content fl-node-content"> <div class="fl-accordion fl-accordion-small fl-accordion-collapse"> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a9b-tab-0" aria-controls="fl-accordion-5b733bd375a9b-panel-0" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a9b-label-0" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a9b-panel-0">American Heart Association</a> <a href="#" id="fl-accordion-5b733bd375a9b-icon-0" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a9b-panel-0" aria-labelledby="fl-accordion-5b733bd375a9b-tab-0" aria-hidden="true"> <p><a href="https://www.heart.org/en/">https://www.heart.org/en/</a></p> <p>2018</p> <p><strong>Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association</strong></p> <p>“On the basis of the available evidence, the writing group concluded that, at this time, it is prudent to advise against prolonged consumption of LCS beverages by children. (Although water is the optimal beverage choice, children with diabetes mellitus who consume a balanced diet and closely monitor their blood glucose may be able to prevent excessive glucose excursions by substituting LCS beverages for sugar-sweetened beverages [SSBs] when needed.) For adults who are habitually high consumers of SSBs, the writing group concluded that LCS beverages may be a useful replacement strategy to reduce intake of SSBs. This approach may be particularly helpful for persons who are habituated to a sweet-tasting beverage and for whom water, at least initially, is an undesirable option.”</p> <p><a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000569">Click here for additional detail</a>.</p> <p> </p> <p>2012</p> <p><strong>Scientific Statement: Nonnutritive Sweeteners: Current Use and Health Perspectives</strong><br /> <em>American Diabetes Association and the American Heart Association</em></p> <p>“The evidence reviewed suggests that when used judiciously, NNS could facilitate reductions in added sugars intake, thereby resulting in decreased total energy and weight loss/weight control, and promoting beneficial effects on related metabolic parameters.”</p> <p><strong>Evaluation methodology:</strong> Literature search</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402256/pdf/1798.pdf">Click here for additional detail</a>.</p> <p><a href="http://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/nonnutritive-sweeteners-artificial-sweeteners"><strong>Website statement:</strong> </a>“Foods and beverages that contain NNSs can be included in a healthy diet, as long as the calories they save you are not added back by adding more foods as a reward later in the day, adding back calories that take you over your daily limit.”</p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a9b-tab-1" aria-controls="fl-accordion-5b733bd375a9b-panel-1" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a9b-label-1" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a9b-panel-1">British Dietetic Association</a> <a href="#" id="fl-accordion-5b733bd375a9b-icon-1" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a9b-panel-1" aria-labelledby="fl-accordion-5b733bd375a9b-tab-1" aria-hidden="true"> <p><a href="https://www.bda.uk.com/">https://www.bda.uk.com/</a></p> <p><strong>2022</strong></p> <p>Resource on Type 2 Diabetes (19 January 2022) “Foods labelled ‘suitable for people with diabetes’ have no special benefit for people with type 1 or type 2 diabetes. Non-nutritive artificial sweeteners are safe and may be recommended as part of your usual healthy, balanced dietary pattern.”</p> <p><a href="https://www.bda.uk.com/resource/diabetes-type-2.html" target="_blank" rel="noopener">Click here for additional detail.</a></p> <p> </p> <p><strong>2016</strong></p> <p><strong>Policy Statement: The Use of Artificial Sweeteners</strong></p> <p>“The BDA believes that:</p> <p>1. Artificial sweeteners available to purchase in the UK are considered safe to consume up to the ADI in the general population with the exception of foods for infants and young children, and are authorised and approved for use by EFSA.</p> <p>2. Opting for an artificial sweeteners may assist in the management of weight and in the management of other health conditions such as diabetes mellitus in some individuals. A tailored individualised approach is required.</p> <p>3. From a dietetic perspective, artificial sweeteners may be included as part of a dietetic intervention, though recommendation should be given on a case-by-case basis.”</p> <p><strong>Evaluation methodology:</strong> Not stated</p> <p><a href="https://www.bda.uk.com/uploads/assets/11ea5867-96eb-43df-b61f2cbe9673530d/policystatementsweetners.pdf" target="_blank" rel="noopener">Click here for additional detail.</a></p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a9b-tab-2" aria-controls="fl-accordion-5b733bd375a9b-panel-2" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a9b-label-2" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a9b-panel-2">Diabetes Canada</a> <a href="#" id="fl-accordion-5b733bd375a9b-icon-2" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a9b-panel-2" aria-labelledby="fl-accordion-5b733bd375a9b-tab-2" aria-hidden="true"> <p><a href="https://www.diabetes.ca/">https://www.diabetes.ca/</a></p> <p>2018</p> <p><strong>Diabetes Canada 2018 Clinical Practice Guidelines: Nutrition Therapy</strong></p> <p>“Most [non-nutritive sweeteners] have been shown to be safe when used by people with diabetes, however, there are limited data on the newer sweeteners, such as neotame and thaumatin in people with diabetes. Although systematic reviews and meta-analyses of prospective cohort studies inclusive of people with diabetes have shown an adverse association of non-nutritive sweetened beverages with weight gain, CVD and stroke, it is well recognized that these data are at high risk of reverse causality. The evidence from systematic reviews and meta-analyses of randomized controlled trials, which give a better protection against bias, have shown a weight loss benefit when non-nutritive sweeteners are used to displace excess calories from added sugars (especially from SSBs) in overweight children and adults without diabetes…”</p> <p><strong>Evaluation methodology:</strong> Not stated</p> <p><a href="https://guidelines.diabetes.ca/cpg/chapter11">Click here for additional detail.</a></p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a9b-tab-3" aria-controls="fl-accordion-5b733bd375a9b-panel-3" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a9b-label-3" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a9b-panel-3">Dietitians of Canada</a> <a href="#" id="fl-accordion-5b733bd375a9b-icon-3" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a9b-panel-3" aria-labelledby="fl-accordion-5b733bd375a9b-tab-3" aria-hidden="true"> <p><a href="https://www.dietitians.ca/">https://www.dietitians.ca/</a></p> <p>2022</p> <p><strong>Are artificial sweeteners safe?</strong></p> <p>Health Canada regulates all sweeteners that are used and sold in Canada. Sweeteners are only approved when scientific evidence confirms that they are considered safe. If you have a condition called phenylketonuria (PKU), avoid foods that have aspartame.</p> <p><a href="https://www.unlockfood.ca/en/Articles/Food-technology/What-Are-the-Different-Types-of-Sweeteners-Are-They-Safe.aspx">Click here for additional detail.</a></p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a9b-tab-4" aria-controls="fl-accordion-5b733bd375a9b-panel-4" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a9b-label-4" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a9b-panel-4">Nutrition Committee of the Spanish Association of Paediatrics</a> <a href="#" id="fl-accordion-5b733bd375a9b-icon-4" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a9b-panel-4" aria-labelledby="fl-accordion-5b733bd375a9b-tab-4" aria-hidden="true"> <p><a href="https://www.analesdepediatria.org/">https://www.analesdepediatria.org/</a></p> <p>2015</p> <p><strong>Use of sugars and sweeteners in children's diets. </strong></p> <ul> <li>“Sweeteners, especially ‘‘non-caloric’’ sweeteners, can help to limit the intake of refined sugars in the diet and are useful for preventing diseases such as obesity and diabetes, in association with a moderate, balanced diet.</li> <li>In view of the recommendation not to add sweeteners to foods intended for infants and very young children, their use is not advisable in children between the ages of 1 and 3 years.</li> <li>It is recommended that health care professionals acquire the appropriate knowledge to advise on and/or choose a particular sweetener on the basis of its properties.</li> <li>There is a continuing need for specific research in order to make appropriate use of sweeteners in children.”</li> </ul> <p><strong>Evaluation methodology:</strong> Not stated</p> <p><a href="http://www.analesdepediatria.org/en-pdf-S234128791500201X">Click here for additional detail</a>.</p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b733bd375a9b-tab-5" aria-controls="fl-accordion-5b733bd375a9b-panel-5" tabindex="0"> <a href="#" id="fl-accordion-5b733bd375a9b-label-5" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b733bd375a9b-panel-5">The Obesity Society</a> <a href="#" id="fl-accordion-5b733bd375a9b-icon-5" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b733bd375a9b-panel-5" aria-labelledby="fl-accordion-5b733bd375a9b-tab-5" aria-hidden="true"> <p><a href="https://www.obesity.org/">https://www.obesity.org/</a></p> <p>2018</p> <p><strong>Low-Calorie Sweeteners and Weight Management: What Does the Future Hold?</strong></p> <p>Most research suggests that LCSs do not increase the incidence of dental caries. Thus, compared with added sugar, LCSs provide beneficial effects for dental caries. Yet, especially compared with water or other nutrient-dense foods and beverages, effects of LCSs on body weight and overall cardiometabolic health outcomes require further investigation in a variety of study populations.</p> <p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22297">Click here for additional detail</a></p> <p>2016</p> <p><strong>The effects of water and non‐nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial</strong></p> <p><em>Obesity (Official Journal of the Obesity Society)</em></p> <p>Water and NNS beverages were not equivalent for weight loss and maintenance during a 1‐year behavioral treatment program. NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program. These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program.</p> <p><strong>Evaluation Methodology</strong></p> <p>The study used a randomized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight‐stable people with overweight and obesity.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744961/">Click here for additional detail</a></p> <p>2013</p> <p><strong>Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults</strong><br /> <em>American Association of Clinical Endocrinologists/The American College of Endocrinology and The Obesity Society</em></p> <p>“Patients with DM may safely consume artificial sweeteners within the guidelines of the U.S. Food and Drug Administration (FDA).”</p> <p><strong>Evaluation methodology:</strong> AACE Protocol for Standardized Production of Clinical Practice Guidelines – 2010</p> <p><strong>Rating:</strong> Grade D, Best Evidence Level 1</p> <p><strong>Rating interpretation:</strong> Expert opinion when there is lack of conclusive clinical evidence. Best evidence level (BEL) 1 = strong</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/24129260/" target="_blank" rel="noopener">Click here for additional detail</a>.</p> <p><em><span style="font-size: 12px;">Resources accessed July 2024.</span></em></p> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="fl-row fl-row-fixed-width fl-row-bg-none fl-node-s4q8cutajdko fl-row-default-height fl-row-align-center" data-node="s4q8cutajdko"> <div class="fl-row-content-wrap"> <div class="fl-row-content fl-row-fixed-width fl-node-content"> <div class="fl-col-group fl-node-1j45cl8dbqax" data-node="1j45cl8dbqax"> <div class="fl-col fl-node-t36e7irg2kyz" data-node="t36e7irg2kyz"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-rich-text fl-node-5b9bd365b958f" data-node="5b9bd365b958f"> <div class="fl-module-content fl-node-content"> <div class="fl-rich-text"> <h2><span class="color-quaternary" style="font-size: 30px;">Other Statements on the Use of Low-Calorie Sweeteners</span></h2> </div> </div> </div> </div> </div> </div> <div class="fl-col-group fl-node-82ysruald0m6" data-node="82ysruald0m6"> <div class="fl-col fl-node-pex6yfoi0aj5 fl-col-small" data-node="pex6yfoi0aj5"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-accordion fl-node-5b9bd365b9641" data-node="5b9bd365b9641"> <div class="fl-module-content fl-node-content"> <div class="fl-accordion fl-accordion-small fl-accordion-collapse"> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b9bd365b9641-tab-0" aria-controls="fl-accordion-5b9bd365b9641-panel-0" tabindex="0"> <a href="#" id="fl-accordion-5b9bd365b9641-label-0" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b9bd365b9641-panel-0">Dietary Guidelines Advisory Committee</a> <a href="#" id="fl-accordion-5b9bd365b9641-icon-0" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b9bd365b9641-panel-0" aria-labelledby="fl-accordion-5b9bd365b9641-tab-0" aria-hidden="true"> <p> </p> <p>2020</p> <p><strong>Dietary Guidelines Advisory Committee Report</strong></p> <p>“Taken together the current review is broadly consistent with findings from the 2015 Committee. However, recognizing that: a) mean responses may not reflect individual responses, b) robust, effective tools to manage body weight are lacking, c) individuals with overweight or obesity are at elevated risk of multiple health complications, and d) multiple national regulatory bodies agree that LNCS can be used safely, the Committee recommends these food ingredients be considered as an option for managing body weight."</p> <p><strong>Evaluation methodology: Systematic review</strong></p> <p>Insufficient evidence is available to determine the relationship between sugar-sweetened beverages compared with low- and no- calorie sweetened beverages on adiposity in children.</p> <p><strong>Rating</strong>: Grade Not Assignable</p> <p>Limited evidence suggests no association between sugar-sweetened beverages compared with low- and no- calorie sweetened beverages on adiposity in adults.</p> <p><strong>Rating</strong>: Limited</p> <p>Limited evidence suggests no association between low- and no-calorie sweetened beverage consumption and adiposity in children.</p> <p><strong>Rating</strong>: Limited</p> <p>Limited evidence suggests that low- and no- calorie sweetened beverage consumption is associated with reduced adiposity in adults.</p> <p><strong>Rating</strong>: Limited</p> <p><a href="https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf" target="_blank" rel="noopener">Click here for additional detail</a>.</p> <p> </p> <p>2015</p> <p><strong>Dietary Guidelines Advisory Committee Report</strong></p> <p>“Moderate and generally consistent evidence from short term RCTs conducted in adults and children supports that replacing sugar-containing sweeteners with low-calorie sweeteners reduces calorie intake, body weight, and adiposity.”</p> <p><strong>Evaluation methodology:</strong> Systematic review</p> <p><strong>Rating:</strong> Moderate</p> <p>“Long-term observational studies conducted in children and adults provide inconsistent evidence of an association between low-calorie sweeteners and body weight as compared to sugar-containing sweeteners.”</p> <p><strong>Evaluation methodology:</strong> Systematic review</p> <p><strong>Rating:</strong> Limited</p> <p><a href="https://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf">Click here for additional detail.</a></p> <p><span style="font-size: 12px;"><em>Resources accessed September 2018.</em></span></p> </div> </div> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5b9bd365b9641-tab-1" aria-controls="fl-accordion-5b9bd365b9641-panel-1" tabindex="0"> <a href="#" id="fl-accordion-5b9bd365b9641-label-1" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5b9bd365b9641-panel-1">Directorate General for Health and Food Safety, European Commission</a> <a href="#" id="fl-accordion-5b9bd365b9641-icon-1" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5b9bd365b9641-panel-1" aria-labelledby="fl-accordion-5b9bd365b9641-tab-1" aria-hidden="true"> <p><a href="https://commission.europa.eu/about-european-commission/departments-and-executive-agencies/health-and-food-safety_en">https://commission.europa.eu/about-european-commission/departments-and-executive-agencies/health-and-food-safety_en</a></p> <p>2018</p> <p><strong>Review of Scientific Evidence and Policies on Nutrition and Physical Activity-Objective B2: Consumption, Energy Intake and Impact of Fruit Juices and of Artificially and Sugar Sweetened Beverages, Summary Report</strong></p> <p>“There is no conclusive evidence that consumption of LCS beverages is associated with changes in body weight or body fat. However, there is some evidence that replacing SSBs with LCS beverages can reduce existing body fat. There is also evidence to suggest a link between consumption of LCS beverages and other behavioral and health impacts such as increased glucose intolerance: further research and assessment of the impact of LCS beverages on health is required.”</p> <p><strong>Evaluation methodology:</strong> Non-systematic literature review. Five steps: (1) refine research questions, (2) develop a search approach and databases, (3) conduct literature searches, (4) screen articles for inclusion, (5) abstract and synthesize relevant data.</p> <p><strong>Rating:</strong> Not applicable</p> <p><a href="https://publications.europa.eu/en/publication-detail/-/publication/63964037-04df-11e9-adde-01aa75ed71a1/language-en/format-PDF/source-84832845" target="_blank" rel="noopener">Click here for additional detail.</a></p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> </div> </div> </div> </div> </div> <div class="fl-col fl-node-jpugw2decbxo fl-col-small" data-node="jpugw2decbxo"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-accordion fl-node-5caf5ca9a262b" data-node="5caf5ca9a262b"> <div class="fl-module-content fl-node-content"> <div class="fl-accordion fl-accordion-small fl-accordion-collapse"> <div class="fl-accordion-item "> <div class="fl-accordion-button" id="fl-accordion-5caf5ca9a262b-tab-0" aria-controls="fl-accordion-5caf5ca9a262b-panel-0" tabindex="0"> <a href="#" id="fl-accordion-5caf5ca9a262b-label-0" class="fl-accordion-button-label" tabindex="0" aria-controls="fl-accordion-5caf5ca9a262b-panel-0">Health Canada</a> <a href="#" id="fl-accordion-5caf5ca9a262b-icon-0" class="fl-accordion-button-icon" tabindex="-1"><i class="fl-accordion-button-icon fl-accordion-button-icon-right fas fa-plus"><span class="sr-only">Expand</span></i></a> </div> <div class="fl-accordion-content fl-clearfix" id="fl-accordion-5caf5ca9a262b-panel-0" aria-labelledby="fl-accordion-5caf5ca9a262b-tab-0" aria-hidden="true"> <p><a href="https://www.canada.ca/en/health-canada">https://www.canada.ca/en/health-canada</a></p> <p>2022</p> <p><strong>Changes to information on sweeteners</strong></p> <p>As part of Health Canada's Healthy Eating Strategy, amendments to the Food and Drug Regulations (FDR) (Nutrition Symbols, Other Labelling Provisions, Vitamin D and Hydrogenated Fats or Oils) were published in the Canada Gazette, Part II on July 20, 2022. Regulated parties have until January 1, 2026 to meet the new requirements…The changes concern foods that contain the following high-intensity sweeteners approved by Health Canada for use in Canada:</p> <ul> <li>Neotame</li> <li>Sucralose</li> <li>Aspartame</li> <li>acesulfame-potassium</li> </ul> <p>These sweeteners don't have to be listed on the front of the package anymore. The amount of the sweetener in mg per serving will no longer appear in the list of ingredients. None of the other approved sweeteners need this extra labelling.</p> <p><a href="https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/food-additives/sugar-substitutes/changes-information-sweeteners.html">Click here for additional detail</a></p> <p>2019</p> <p><strong>Canada’s Dietary Guidelines</strong></p> <p>“Sugar substitutes do not need to be consumed to reduce the intake of free sugars.”</p> <p>“…as there are no well-established health benefits associated with the intake of sweeteners, nutritious foods and beverages that are unsweetened should be promoted instead.”</p> <p><strong>Evaluation methodology:</strong> “Adapted from established methods for developing guidelines.”</p> <p><strong>Rating:</strong> Not applied</p> <p><a href="https://food-guide.canada.ca/en/guidelines/" target="_blank" rel="noopener">Click here for additional detail. </a></p> <p><span style="font-size: 12px;"><em>Resources accessed July 2024.</em></span></p> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="fl-row fl-row-fixed-width fl-row-bg-none fl-node-06pwim5kvjrc fl-row-default-height fl-row-align-center" data-node="06pwim5kvjrc"> <div class="fl-row-content-wrap"> <div class="fl-row-content fl-row-fixed-width fl-node-content"> <div class="fl-col-group fl-node-cvwlpt3h5ubi" data-node="cvwlpt3h5ubi"> <div class="fl-col fl-node-qvm97w0blrn4" data-node="qvm97w0blrn4"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-rich-text fl-node-5b9fbf4fbabd9" data-node="5b9fbf4fbabd9"> <div class="fl-module-content fl-node-content"> <div class="fl-rich-text"> <p style="text-align: center;">View an overview of <a href="../safety-assessments-of-low-calorie-sweeteners/" target="_blank" rel="noopener">Regulatory Safety Assessments of the Use of Low-Calorie Sweeteners</a>.</p> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="fl-row fl-row-fixed-width fl-row-bg-none fl-node-5b733bd3754a0 fl-row-default-height fl-row-align-center" data-node="5b733bd3754a0"> <div class="fl-row-content-wrap"> <div class="fl-row-content fl-row-fixed-width fl-node-content"> <div class="fl-col-group fl-node-5b733bd37574a" data-node="5b733bd37574a"> <div class="fl-col fl-node-5b733bd3757cb" data-node="5b733bd3757cb"> <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-rich-text fl-node-5b733bd375708" data-node="5b733bd375708"> <div class="fl-module-content fl-node-content"> <div class="fl-rich-text"> <p><span class="ms-rteThemeFontFace-2 ms-rteFontSize-2">IAFNS intends to keep this resource up to date. 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